The invention relates generally to medical tables and, more particularly, to an improved bi-level medical table that is compact, adjustable, and easily draped.
Various types of specialized equipment are used to perform surgeries and other medical procedures. In particular, stainless-steel tables found in doctor's offices and operating rooms are used to hold a wide variety of sterilized medical instruments and supplies during surgical or other medical procedures.
Such tables arose from the need to place medical instruments and accessories within easy reach of doctors and nurses during medical or surgical procedures, and from requirements that medical instruments and supplies, as well as work surfaces of the table itself, be sterilized prior to use and kept sterile until used.
For example, many hospital regulations require routine sterilization of all parts of medical tables used in surgery that are at about thirty inches or more above the floor of an operating room. As another example, the Centers For Disease Control and various medical organizations strongly recommend the routine sterilization of medical instruments, examination tables, and other medical equipment. Because most conventional surgical tables are not easily disassembled for sterilization, the sterilization requirements are typically met by laying a sterilized disposable drape (cover) on the table surface(s) prior to the start of a medical procedure and then disposing of the drape(s) after the procedure is completed. In contrast, medical instruments and supplies are typically sterilized in an autoclave located in the hospital or other healthcare facility. Examples of acceptable instrument sterilization methods include steam under pressure, dry heat, chemical vapor, radiation, cold sterilization, or ethylene oxide gas.
Conventional surgical tables are typically made from surgical grade stainless steel and their size makes them bulky and awkward to use. Such tables generally have two or more horizontal shelves stacked one above the other and attached to four upright corner posts. The edges of the shelves and other parts of the tables are typically rounded to avoid snagging or tearing a sterilized disposable surgical drape that is laid over a particular shelf or shelves. To provide mobility, such tables are commonly equipped with an anti-static wheel at each bottom corner. The lower and upper shelves of conventional tables are structured to hold instrument sterilization trays and baskets, lap trays, scope trays, plastic baskets, wire baskets, packaged medical supplies and accessories, and other health care products.
The sizes of conventional tables vary, but a typical surgical table measures about seventy-two inches wide, about thirty-four inches high, and about twenty-four inches deep, and has a unibody construction that prevents sterilizing the table (or its components) in standard hospital autoclaves, which typically measure about three feet wide, about six feet tall, and about five feet deep. Thus, conventional surgical tables used in the operating rooms of most hospitals cannot be readily sterilized using steam under pressure, dry heat, chemical vapor, or other types of sterilization methods. Consequently, the shelves of conventional surgical tables are covered with sterile disposable surgical drapes prior to use. A typical use of a conventional surgical table is described below.
Prior to a surgery, a nurse or technician will prepare the operating room. This is typically accomplished by cleaning the surgical table using a hand-scrubbing method and/or an ultrasonic cleaning method. Once the table is cleaned, the nurse covers the table's work surface(s) with a sterilized disposable surgical drape (or drapes). After the drape(s) have been properly positioned, the nurse loads previously sterilized medical instruments and/or supplies directly onto the surgical drape(s). Generally, the instruments themselves will have been removed from the hospital autoclave a short time before; however, sterilized pre-packaged instruments and/or supplies may be loaded onto the drapes as well. Typical medical instruments and/or supplies may include kits of surgical instruments and medical devices and materials appropriate to the particular surgery that will be performed, as well as autoclave instrument sterilization trays and other sterilization receptacles. Depending on the medical procedure involved, it is not uncommon for a six foot long conventional surgical table to be covered from end to end (and front to back) with sterilized instruments and/or supplies by the time the nurse completes the preparations.
During surgery, the nurse is typically positioned between the doctor and the surgical table. From this position, the nurse can retrieve sterilized instruments and/or supplies and hand them to the doctor as necessary. The nurse can also take contaminated instruments from the doctor and place them on the surgical drape or in sterilization receptacles that were pre-positioned on the surgical table. Because most conventional surgical tables are about six feet long, the nurse often has to move back and forth from one end of the table to the other in order to retrieve (or set down) a sterilized or contaminated item. The size of the table hinders free and easy movement of the table and the people in and around the operating room. Small operating rooms further exacerbate this problem, because the bulky dimensions of a conventional surgical table leaves the nurse (and/or doctor(s)) with little floor space in which to work. Additionally, instruments and/or drapes positioned on the table may fall to the floor if the table is bumped or a drape is snagged. After the surgery or other medical procedure is finished, the drapes are considered to be biohazards, and must be properly incinerated, which increases disposal costs and adds regulatory compliance.
Health care equipment suppliers have proposed numerous approaches for configuring surgical tables and methods for sterilizing them. For instance, one conventional configuration solution adds a top shelf to the table. This top shelf is as long as the table top, but slightly narrower. Although the plane of the top shelf is not adjustable relative to the plane of the table top, the top shelf may be raised and lowered between heights of about twelve inches to about fifteen inches above the table top. This adjustability feature allows persons of about five feet four inches or less to reach instruments on the top shelf without having to use step stools. However, this conventional approach suffers drawbacks in that in addition to traversing the six foot length of the table, the nurse may also have to tilt the trays or baskets on the top shelf and/or stand on tiptoe or on a step stool) to see what instruments and/or supplies are inside. Moreover, instrument trays and other supplies are likely to fall off the narrow top shelf and cascade onto those on the table top. Additionally, use of the top shelf requires an extra disposable drape, which increases the hospital's overhead costs.
Yet another approach, disclosed in U.S. Pat. No. 4,927,214 to Kaufman et al., provides an operating room instrument table assembly formed of a plurality of modular table units. Each table unit includes castor wheel supports, a base frame attached to the castor wheel supports, a table top support frame connected to the base frame, and a removable table top detachably connected to the table top support frame. The removable table top is sterilizable as a unit with the instruments used in a medical procedure. The bare frame includes two upright posts. The table top support frame includes two tabular supports connected by a center connector. Each tabular support is sized to fit over one of the upright posts.
One disadvantage of this operating room instrument table is that it consumes a large area of floor space since only a single table top is included for each movable base/table support frame. Further, if a larger work area is desired, then separate table tops, each on its own movable base, must be disposed side-by-side, and or in a circular configuration, with the surgeon or nurse in the middle. This leads to yet another disadvantage, which is that the person handling the instruments is not free to move about the operating room, but rather is confined within the center of the modular table units. To move about the operating room, the person must push one of the modular table units out of position, and risk bumping another table unit and thereby knocking instruments into disarray and/or onto the floor. Additionally, to access instruments during a medical procedure, the person may be required to move back and forth from one portion of the table to another. During long medical procedures, this may generate fatigue and/or increase the risk that instruments may be bumped and/or dropped. In addition, only the table top is removable for sterilization. The table support frame (e.g. tubular supports connected by a center connector) remains connected to the movable base, and thus is not sterilizable with the removable table top and/or the instruments.
Another approach is disclosed in U.S. Pat. No. 6,189,459 to DeAngelis, which describes a collapsible auxiliary instrument shelf for use in surgical operating rooms. As described in this patent, a conventional surgical table includes a main shelf that is supported at each corner by a leg. A castor is attached to the bottom of each leg. The auxiliary shelf is supported above the main shelf by a pair of posts. Each post is affixed to one of the rear legs that support the main shelf.
One disadvantage of this apparatus is that neither the auxiliary shelf nor the surgical table to which it is attached are detachable for sterilization. Another disadvantage is that paper and/or clear plastic surgical drapes, with all the drawbacks referenced above, must be used to cover the auxiliary shelf and table before the auxiliary shelf and table can be used in surgery. A further disadvantage is that the auxiliary shelf cannot be angled relative to the main shelf. Consequently, it is difficult for a user of the table to view and/or access items placed on the auxiliary shelf.
Yet another proposed approach is disclosed in U.S. Pat. No. 5,551,674 to Boyd, et al., which discloses an accessory tray for use in a surgery, and, more particularly, a sterilizable accessory tray for supporting absorbent material pads for use in neurosurgery. The tray is supported on a conventional surgical stand, which has a movable base, an adjustable support pole attached the base, and a single shelf cantilevered from the top of the support pole. The accessory tray is removable from and in a fixed angular position relative to the shelf of the surgical stand. However, the shelf and other parts of the surgical stand cannot be readily disassembled and sterilized. Preferably, the accessory tray is made of a disposable plastic material, but it may also be made of a sterilizable plastic or metal material.
A disadvantage of the accessory tray of Boyd, et al. is that the tray is particularly adapted to store sterile absorbent pads commonly used in neurosurgery to absorb blood or retain accumulated blood or brain fluids, meaning it has little if any utility for other medical procedures. Although the accessory tray may be removed from the shelf and sterilized, the tray, much like a surgical drape, is preferably removed and thrown away. Consequently, each use of the surgical stand requires either a new sterilized disposable drape or a new sterilized accessory tray. Another disadvantage of this apparatus is that the shelf of the surgical stand is equipped with a continuous raised lip that tends to retain blood and other fluids drained from any used surgical instruments and/or supplies that may be placed on the shelf during a procedure.
Recent medical studies have generated stringent sterilization requirements, most of which are difficult or impossible to satisfy simply by hand cleaning and ultrasonic cleaning alone. In addition to being bulky and non-ergonomic, conventional surgical tables are difficult to sterilize and are costly because they require the use of expensive sterilized disposable drapes.
Thus, there is a need for an improved configuration of a surgical table, particularly a compact table, used during surgery in a hospital operating room, which is easier to sterilize and use in surgery than conventional surgical tables.